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Why doctors pay millions in fees that could be spent on care

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41–50 of 79 posts

Re: Why doctors pay millions in fees that could be spent on care

#41
Possibly naive, but hopefully trying to reason from first principles:

The insurance companies are the ones paying for care. The hospital systems are the ones charging for care. The entity that pays for care has every incentive to keep costs _low_. The entity that charges for care has every incentive to charge as much as possible. i.e. The ire of consumers should be directed at hospital systems rather than insurance companies.

Re: Why doctors pay millions in fees that could be spent on care

#42

Medical Billing is ripe for disruption, but of note, I don't know of any startup that has made significant inroads into this market. Anyone know why its so tough to break?

Because Epic is deeply integrated everywhere. It’s like trying to dislodge SAP; good luck with that.

Re: Why doctors pay millions in fees that could be spent on care

#43
post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

> A better way to solve the problem is to go with a single-payer healthcare system

Possibly. But there are countries in Europe where healthcare is primarily or to a large degree (or even entirely like in Switzerland, they don't even have any Medicare/Medicaid equivalents) financed through private insurance systems. Yet they manage to keep prices from spiraling through effective regulation.

Re: Why doctors pay millions in fees that could be spent on care

#44
post #41

Possibly naive, but hopefully trying to reason from first principles: The insurance companies are the ones paying for care. The hospital systems are the ones charging for care. The entity that pays for care has every incentive to keep costs _low_. The entity that charges for care has every incentive to charge as much as possible. i.e. The ire of consumers should be directed at hospital systems rather than insurance c…

IIRC, insurance companies benefit from high prices, as it benefits their gross profits. I forget whether that was due to regulations sort of capping profit margins, or what the reason was. I’ll see if I can track down a reference.

Edit: here’s an article on the topic https://www.npr.org/sections/health-shots/2018/05/25/6136857...

Re: Why doctors pay millions in fees that could be spent on care

#45
post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

Single-payer is not actually that common, it just seems that way because Canada is next to us. The UK goes beyond that to single-provider. France, Germany, and Japan have multiple private insurance companies and get fantastic results without spending too much, but they also have a national price list for medical services, no claim denials allowed for anything on the list, and a national digital medical records system.

Source: The Healing of America by T.R. Reid.

Re: Why doctors pay millions in fees that could be spent on care

#46
post #34
post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

Not every first world country has a true single-payer healthcare system. There are many variations that work better than what we have. The difference is that in the US we have accepted profit maximization as the legitimate primary goal in the healthcare system.

I think the majority of Western European countries don't even have it? Most seem to have mixed systems or no single payer at all like Switzerland (where healthcare is privatized to an even higher degree than in the US).

Re: Why doctors pay millions in fees that could be spent on care

#47
post #43
post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

> A better way to solve the problem is to go with a single-payer healthcare system Possibly. But there are countries in Europe where healthcare is primarily or to a large degree (or even entirely like in Switzerland, they don't even have any Medicare/Medicaid equivalents) financed through private insurance systems. Yet they manage to keep prices from spiraling through effective regulation.

Yes, but Switzerland also subsidizes premiums if your income is too low relative to the premium; and healthcare coverage is mandated by law.

I don't know Swiss politics but I also assume there isn't a bickering back-and-forth by party lines that end up distorting/underfunding any sort of healthcare.

Re: Why doctors pay millions in fees that could be spent on care

#48

Would love to see doctors and medical facilities nationwide convert, en masse, to paper checks. Let's see how quickly the insurers back off the fees.

They would absolutely love it. Paper checks extend their accounts payable.

Plus think of all the opportunities for checks to get “sent” but “lost in the mail”, sent for the incorrect amount (always lower than the amount owed,) and not be eligible for payment at all until the provider accrues a certain dollar amount…

Endless possibilities!

Re: Why doctors pay millions in fees that could be spent on care

#49
Is it more efficient to get a bundle of cash spread over 5 years and to disincentivize abuse/overuse, get tax credit for unused money?

The insane paperwork we've built-up thanks to the industry isn't really serving our colletive best interests.

Re: Why doctors pay millions in fees that could be spent on care

#50
post #41

Possibly naive, but hopefully trying to reason from first principles: The insurance companies are the ones paying for care. The hospital systems are the ones charging for care. The entity that pays for care has every incentive to keep costs _low_. The entity that charges for care has every incentive to charge as much as possible. i.e. The ire of consumers should be directed at hospital systems rather than insurance c…

That is the way it used to be. For many of us in high deductible plans, we pay thousands of dollars each year for care before the insurance company pays for anything. Not to mention the thousands of dollars we pay each year in premiums to the insurance company.
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